Healthcare Provider Details

I. General information

NPI: 1316452501
Provider Name (Legal Business Name): PROFESSIONAL STAFFING SOLUTIONS ADULT DAY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2017
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 BROADWAY EXT N # P
GREENVILLE MS
38703-1942
US

IV. Provider business mailing address

PO BOX 4580
GREENVILLE MS
38704-4580
US

V. Phone/Fax

Practice location:
  • Phone: 662-335-5554
  • Fax: 662-335-5580
Mailing address:
  • Phone: 662-335-5554
  • Fax: 662-335-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberR863014
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberR863014
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberR863014
License Number StateMS

VIII. Authorized Official

Name: MRS. PANDORA REDMOND
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 662-822-1924